A Virtual Arm to Stop Smoking

A comparative study

B. Girard1, V. Turcotte1 and S. Bouchard2

1. GRAP, Occupational psychology clinicSaguenay (Québec) Canada

2. University Quebec Outaouais, (Québec) Canada

Cybertherapy and behaviour conferenceSan Diego, U.S.A., June 23-24th 2008

TO STOP SMOKING

VIRTUAL ARM

PILOT STUDY 2007

OBSERVATIONS :

1. Usability of the method for smokers and clinicians.

2. Some clinical evidences of modifying craving and smoking behaviours.

3. An action-cue exposure (ACET) strategy could be considered in the treatment of substance addiction.

Hypothesis: in the treatment of tobacco addiction, crushing cigarettes with a virtual arm will have a higher efficiency than catching balls after four sessions of cybertherapy (1month) and at the end of psychosocial support (3 months).

The difference will be calculated by the percentage

of non smokers, the reduction of daily consumption

and the intensity of the symptoms of dependence

and withdrawal.

OBJECTIVES

A comparative study on 91 smokersJanuary – May 2008

PRESENTATION :

• Method

• Preliminary results

STUDY DESIGN

• Combined therapy : cybertherapy + psychosocial support

(no medication)• 91 subjects randomized• Two conditions :

active : crushing cigarettes

control : catching balls• No target quit date• Study is submitted to the ethical board of UQO

(University Quebec Outaouais)

STUDY POPULATION

• Recruitment : Through local media

• Preselecting :By phone

• Selection :Selection :In-clinic visit

PRESELECTING (by phone)

• Inclusion criteria :Age between 18 – 65Daily smoking 10 cigarettes and more (last year)Fewer than 3 months abstinence (last year)Motivated to stop smoking

• Exclusion criteria :Any serious or unstable disease (6 months)Treatment for major mental illness (last year)Use of medication to stop smoking (6 months)Regular use of CNS medicationTreatment with cybertherapy (last year)History of severe substance abuse (last year)Pregnancy

SELECTION (clinic visit)

• Physical data : vital signsbody mass index

• Smoking history :age at beginningdurationno attemptsabstinence periodsmean daily use

• Exhaled co test• Questionnaires• VR adaptation session (10 min.) and tests• Consent’s document• Randomization

INTERVENTION

1.0 Psychosocial support • Brief individual counselling (10-15 min) by a nurse :

assist in problem solving, give information on withdrawal, analyse smoker’s journal.

• Smoking cessation selfhelp booklet : guide to becoming a non smoker Health Canada 2003.

• Exhaled co test, vital signs and body mass index.• Questionnaires.• Frequency of visits : - weekly for 1 to 4th week

- biweekly for 6th to 12th week• Medical counselling (if necessary)

INTERVENTION

2.0 Cybertherapy

• Four weekly sessions : week 1 to 4th

• Time : 30 min.

• Scenario : catching balls or crushing cigarettes (max. 50 objects)

• Questionnaires

• Waiting time after exposition : 10-15 min.

• Pentium IV with nVidia 7300GS video card capable of stereoscopy

• eMagin Z800 HMD• Logitech wireless gamepad

• 3D work was integrated into a well-know game engine call Unreal 2 from the game Unreal Tournament 2004

• XSI from Softimage was used for the virtual arm and environment’s creation

EQUIPMENTS

Measures : (at each clinic visit)

• Smoking status : - Self report - Journal of 7 or 14 last days - Exhaled co test

• Motivation : - Richmond test (Richmond 1993)• Dependence : - Fagerström test (Heatherton,

1991) - CDS-12 (Etter, 2002) - Horn test (Taytard, 1999)

• Withdrawal : - Tiffany test (Toll, 2006) - Minnesota test (Hugues, 1986)

• VR reaction : - State of presence - Cybersickness - Neuropsychological symptoms

PRELIMINARY RESULTS

Participant disposition215 respondents

110 screened

96 randomized

91 included

46 actives(cigarettes)

6 weeks - 35

12 weeks - 23

45 controls(balls)

6 weeks - 21

12 weeks - 13

PRELIMINARY RESULTS

Drop out rate :

ACTIVES CONTROLS

6 weeks 11/46 - 23,9% 24/45 - 53,3%

12 weeks 23/46 - 50,0% 32/45 - 71,1%

PRELIMINARY RESULTS

Demographic characteristics

ACTIVE CONTROL

AGE : 18 – 30

31 – 50

51 et +

7 6

20 23

19 16

SEXE : F

M

27 25

19 20

OCCUPATION: Yes

No

34 34

12 11

PRELIMINARY RESULTSSmoking history

ACTIVE CONTROL

Daily consumption (No cig/day) : 10 - 20 30 20

21 - 30 12 17

31 et + 4 8

No attempts : 0 – 3 26 20

4 et + 17 22

Age at beginning (years): 18 et - 42 41

19 - 30 3 4

31 et + 1 0

Duration (no years) : 0 - 10 5 5

11 - 30 19 21

31 et + 22 19

DAIL Y C ONS UMP T ION

0

5

10

15

20

25

1 2 3 4 5 6 7 8 9 10 11 12 WE E K

CIG

./DAY

(MEA

N)

ball

c igarette

Cybertherapy